Individual
NATHAN A MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3050 E RIVER BLUFF BLVD, OZARK, MO 65721
(417) 820-5610
Mailing address
3050 E RIVER BLUFF BLVD, OZARK, MO 65721-8807
(417) 820-5610
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2013001193
MO
Other
Enumeration date
01/23/2013
Last updated
07/19/2018
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